Background and Objectives: Fibrin sealant (FS) is widely used to reduce postoperative bleeding. This analysis aimed to assess the efficacy of FS to reduce complications after rhinoplasty.Materials and Method We searched PubMed, Scopus, Embase, the Cochrane Library, and the Web of Science database for articles on FS and rhinoplasty from the inception of publication to December 29, 2021. Post-rhinoplasty complications, such as edema and ecchymosis, were recorded. The final meta-analysis was performed using three studies. Results: Two subgroups were created based on the FS usage after rhinoplasty. The FS effect on edema reduction was favorable on the postoperative day-1 (standardized mean difference [SMD]=-1.07 [-1.70; -0.45]). In addition, the FS effect on ecchymosis reduction was favorable on the postoperative day-1 postoperative (SMD=-1.33 [-2.15; -0.50]). Conclusion Our study shows that FS reduces the early complications of rhinoplasty.

Background: The coronavirus disease-2019 (COVID-19) pandemic has contributed to the change in the epidemiology of many infectious diseases. This study aimed to establish the pre-pandemic epidemiology of pediatric invasive bacterial infection (IBI). Methods: A retrospective multicenter-based surveillance for pediatric IBIs has been maintained from 1996 to 2020 in Korea. IBIs caused by eight bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, Streptococcus agalactiae, Streptococcus pyogenes, Listeria monocytogenes, and Salmonella species) in immunocompetent children > 3 months of age were collected at 29 centers. The annual trend in the proportion of IBIs by each pathogen was analyzed. Results: A total of 2,195 episodes were identified during the 25-year period between 1996 and 2020. S. pneumoniae (42.4%), S. aureus (22.1%), and Salmonella species (21.0%) were common in children 3 to 59 months of age. In children ≥ 5 years of age, S. aureus (58.1%), followed by Salmonella species (14.8%) and S. pneumoniae (12.2%) were common. Excluding the year 2020, there was a trend toward a decrease in the relative proportions of S. pneumoniae (rs = −0.430, P = 0.036), H. influenzae (rs = −0.922, P < 0.001), while trend toward an increase in the relative proportion of S. aureus (rs = 0.850, P < 0.001), S. agalactiae (rs = 0.615, P = 0.001), and S. pyogenes (rs = 0.554, P = 0.005). Conclusion In the proportion of IBIs over a 24-year period between 1996 and 2019, we observed a decreasing trend for S. pneumoniae and H. influenzae and an increasing trend for S. aureus, S. agalactiae, and S. pyogenes in children > 3 months of age. These findings can be used as the baseline data to navigate the trend in the epidemiology of pediatric IBI in the post COVID-19 era.

Background and Objectives: To investigate the effects of recurrent tonsillitis on postoperative outcomes after powered intracapsular tonsillectomy and adenoidectomy (PITA) in children with obstructive sleep-disordered breathing (oSDB). Materials and Methods: Children who underwent PITA in Kyung Hee University Hospital at Gangdong from 2016 to 2018 were classified into two oSDB groups according to comorbid chronic/recurrent acute tonsillitis (CHT). To evaluate the efficacy of the PITA technique, quality of life (QoL) was measured using the obstructive sleep apnea questionnaire (OSA-18) for 3 months after surgery. To evaluate the disadvantages of the PITA technique, we followed complications such as throat pain, otalgia, nausea, vomiting, and postoperative bleeding for 1 week after surgery. Finally, we compared the pre- and postoperative QoL and analyzed the incidence of postoperative complications in the oSDB with CHT (SDBwCHT) and oSDB without CHT (SDBsCHT) groups. Results: Of the 802 enrolled patients, 135 were classified as SDBwCHT and 667 as SDBsCHT. Both groups exhibited marked improvements in QoL after PITA. The SDBwCHT group showed a change of OSA-18 score from 70.7±17.0 to 31.2±11.4. The SDBsCHT group showed a change of OSA-18 score from 70.0±17.1 to 31.0±9.9. The groups did not demonstrate statistical differences in complication rates and severity of symptoms during the first postoperative week. Conclusion Although comorbid CHT delayed improvement in postoperative symptoms, PITA is a useful technique to treat children with oSDB, regardless of CHT.

Objective: This study compared the prognostic performance of the following five injury severity scores: the Geriatric Trauma Outcome Score (GTOS), the Injury Severity Score (ISS), the New Injury Severity Score (NISS), the Revised Trauma Score (RTS), and the Trauma and Injury Severity Score (TRISS) for in-hospital mortality in severe geriatric trauma patients. Methods: A retrospective, cross-sectional, observational study was conducted using a database of severe geriatric trauma patients (age ≥65 years and ISS ≥16) who presented to a single regional trauma center between November 2016 and October 2018. We compared the baseline characteristics between the survivor and mortality groups and the predictive ability of the five scoring systems. Results: A total of 402 patients were included in the analysis; the in-hospital mortality rate was 25.6% (n=103). The TRISS had the highest area under the curve of 0.953 (95% confidence interval [CI], 0.927-0.971); followed by RTS, 0.777 (95% CI, 0.733-0.817); NISS, 0.733 (95% CI, 0.687-0.776); ISS, 0.660 (95% CI, 0.612-0.707); and GTOS, 0.660 (95% CI, 0.611-0.706) in severe geriatric trauma. The TRISS also had the highest area under the curve of 0.961 (0.919-0.985) among the injury severity scoring systems in polytrauma. The predictive ability of TRISS was significantly higher than the other four scores with respect to overall trauma and polytrauma (P<0.001). Conclusion The TRISS showed the highest prognostic performance for predicting in-hospital mortality among all the injury severity scoring systems in severe geriatric trauma.

Objective: This study compared the prognostic performance of the following five injury severity scores: the Geriatric Trauma Outcome Score (GTOS), the Injury Severity Score (ISS), the New Injury Severity Score (NISS), the Revised Trauma Score (RTS), and the Trauma and Injury Severity Score (TRISS) for in-hospital mortality in severe geriatric trauma patients. Methods: A retrospective, cross-sectional, observational study was conducted using a database of severe geriatric trauma patients (age ≥65 years and ISS ≥16) who presented to a single regional trauma center between November 2016 and October 2018. We compared the baseline characteristics between the survivor and mortality groups and the predictive ability of the five scoring systems. Results: A total of 402 patients were included in the analysis; the in-hospital mortality rate was 25.6% (n=103). The TRISS had the highest area under the curve of 0.953 (95% confidence interval [CI], 0.927-0.971); followed by RTS, 0.777 (95% CI, 0.733-0.817); NISS, 0.733 (95% CI, 0.687-0.776); ISS, 0.660 (95% CI, 0.612-0.707); and GTOS, 0.660 (95% CI, 0.611-0.706) in severe geriatric trauma. The TRISS also had the highest area under the curve of 0.961 (0.919-0.985) among the injury severity scoring systems in polytrauma. The predictive ability of TRISS was significantly higher than the other four scores with respect to overall trauma and polytrauma (P<0.001). Conclusion The TRISS showed the highest prognostic performance for predicting in-hospital mortality among all the injury severity scoring systems in severe geriatric trauma.

Objective: Trauma death is one of the most preventable deaths by various efforts in the healthcare sector. The establishment of a regional trauma center will aid in efforts to reduce mortality. On the other hand, the effects of trauma centers on pediatric trauma in Korea are not fully understood. This study compared the clinical outcomes of severe pediatric trauma patients before and after the regional trauma center was set into action. Methods: A cross-sectional, retrospective analysis was performed on the medical records in a single regional emergency and trauma center from November 2014 to October 2016 and from January 2017 to December 2018. The general demographic information, injury details, and clinical outcome data were collected. The cases were divided into two groups, the before and after groups, and comparisons were made. Results: Seventy-three patients were included in the study. Thirty-seven patients were in the before group, and 36 were in the after group. The mortality (21.6% to 5.6%, P=0.04) and interhospital transfer rate (27.0% to 8.3%, P=0.03) were lower in after group than in the before group. On the other hand, the time to receive a transfusion, operation, and intensive care unit (ICU) admission did not differ significantly. The lengths of the emergency department, ICU, and hospital stay were also similar in the two groups. Conclusion For severe pediatric trauma patients, the mortality and transfer rates decreased after implementing the trauma center. On the other hand, the implementation itself was not identified as a major factor, and the time required to receive a definite treatment or length of stay did not change significantly.

BACKGROUND AND PURPOSE: Cluster headache (CH) is frequently either not diagnosed or the diagnosis is delayed. We addressed this issue by developing the self-administered Cluster Headache Screening Questionnaire (CHSQ). METHODS: Experts selected items from the diagnostic criteria of CH and the characteristics of migraine. The questionnaire was administered to first-visit headache patients at nine headache clinics. The finally developed CHSQ included items based on the differences in responses between CH and non-CH patients, and the accuracy and reliability of the scoring model were assessed. RESULTS: Forty-two patients with CH, 207 migraineurs, 73 with tension-type headache, and 18 with primary stabbing headache were enrolled. The CHSQ item were scored as follows: 3 points for ipsilateral eye symptoms, agitation, and duration; 2 points for clustering patterns; and 1 point for the male sex, unilateral pain, disability, ipsilateral nasal symptoms, and frequency. The total score of the CHSQ ranged from 0 to 16. The mean score was higher in patients with CH than in non-CH patients (12.9 vs. 3.4, p < 0.001). At a cutoff score of >8 points, the CHSQ had a sensitivity, specificity, positive predictive value, and negative predictive value of 95.2%, 96%, 76.9%, and 99.3%, respectively. CONCLUSIONS: The CHSQ is a reliable screening tool for the rapid identification of CH.
Cluster Headache* ; Diagnosis ; Dihydroergotamine ; Headache ; Headache Disorders, Primary ; Humans ; Male ; Mass Screening* ; Migraine Disorders ; Prevalence ; Sensitivity and Specificity ; Tension-Type Headache

The authors regret that one co-author (Kyung-Hyo Kim) was missing in the article.

BACKGROUND AND OBJECTIVES: The demand for rhinoplasty has been high for both men and women over the years; recently, however, it is rapidly increasing for men as their interest in aesthetics has heightened. This study investigated the psychological characteristics of male patients who underwent rhinoplasty through questionnaire-guided consultation. In addition, we investigated the difference between patients and surgeons regarding their aesthetic concerns for rhinoplasty. SUBJECTS AND METHOD: Of the male patients who underwent rhinoplasty from January 2006 to December 2012, 124 patients who had completed the questionnaires were included. The questionnaire for rhinoplasty asked about the basic personality traits of patients, patients' complaints about their nose, reasons for receiving the operation and expectation for postoperative change. RESULTS: Patients responded most to the item, “I have high expectations for the surgery” for the question regarding personality characteristics, followed by the response, “I am concerned about my health.” Regarding questions about reasons for rhinoplasty, complaints about their dorsum were high; among these patients, they were most concerned about the appearance of the ‘crooked nose’ when viewed from the front. On the other hand, the concern for the ‘poorly defined nasal tip’ was not high, whereas it was defined as one of the problems mentioned by the surgeons. CONCLUSION: These results show differences regarding aesthetic concerns between the patients and the surgeon, especially regarding the nasal tip. It would be helpful for both patient and surgen to plan the surgery after careful consultation based on the questionnaire, accurate understanding of the patients' complaints and expectations to obtain satisfactory results for both.
Anxiety ; Esthetics ; Female ; Hand ; Humans ; Male* ; Methods ; Nose ; Psychology ; Rhinoplasty* ; Surgeons

OBJECTIVE: A massive transfusion (MT) of 10 or more units of packed red blood cells (PRCs) focuses on the summation volumes over 24 hours. This traditional concept promotes survivor bias and fails to identify the “massively” transfused patient. The critical administration threshold (≥3 units of PRCs per hour, CAT+) has been proposed as a new definition of MT that includes the volume and rate of blood transfusion. This study examined the CAT in predicting mortality in adult patients with severe trauma, compared to MT. METHODS: Retrospective data of adult major trauma patients (age≥15 years, Injury Severity Score [ISS]≥16) from a regional trauma center collected between May 2016 and June 2017 were used to identify the factors associated with trauma-related death. Univariate associations were calculated, and multiple logistic regression analysis was performed to determine the parameters associated with in-hospital mortality. RESULTS: A total of 540 patients were analyzed. The median ISS was 22, and the hospital mortality rate was 30.9% (n=92). Forty-two (7.8%) and 23 (4.3%) patients were CAT+ and traditional MT+, respectively. Severe brain injury, CAT+, acidosis, and elderly age were significant variables in multivariate analysis. CAT+ was associated with a fourfold increased risk of death (odds ratio, 4.427; 95% confidence interval, 1.040–18.849), but MT+ was not associated (odds, 1.837; 95% confidence interval, 0.376–8.979). CONCLUSION: The new concept of CAT for transfusion was a more useful validation concept of mortality in adult severe trauma patients on admission than traditional MT. Encompassing both the rate and volume of transfusion, CAT is a more sensitive tool than common MT definitions.
Acidosis ; Adult* ; Aged ; Animals ; Bias (Epidemiology) ; Blood Transfusion ; Brain Injuries ; Cats ; Erythrocytes ; Hospital Mortality ; Humans ; Injury Severity Score ; Logistic Models ; Mortality* ; Multiple Trauma ; Multivariate Analysis ; Retrospective Studies ; Survivors ; Trauma Centers